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7 =Z �L 1� Permit No. --- - i 1 . APPLICATION FOR SANITATION PERMIT / (Complete in Duplica}e) Date Issued tComp - __ 1--�� s A San Joaquin Local Health District for a permit to construct and install the work herein described. Applica+ion is hereby made to the This appl+cation is made +n compliance with County Ordinance No. 549. c t - - JOB ADDRESS AND CATION. _ Phone-------- ------- Owner's Name--- - --- --------------- Address_..__-_-..�__/.1?-- -,� 114 j_p_h�. Phone Contractor's. Name__. =. � « Motel Other ❑ + Apartment House ❑ Commercial [�Tra+ler Court ❑ r ❑ �� . _ p Ins#allatLon will serve: Residence Number of living units: _______ Number of bedrooms -------- Number of baths -_...__. Lot size ___---- /--- f+: Private (]r Depth to Water fable _ F Water'Supply: Public system❑ Community system ❑ Clay Loam ❑ Clay ❑ Adobe O--Hardpan ❑ Gravel ❑ Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ I on Made: Yes [I' No 0---New Construction: Yes D�No ❑ Previous Application � '-"'+..• TYPE 'OF INSTALLATION AND SPECIFICATIONS: sewer.is available within 200 feet.) " l G No se tic tank or cesspool permitted if p c --- ----------- + p�, C Mafienal__. _ ,. Ca acit �O �! Septic Tank: Distance from nearest well--/ �------Distance from foundation--�a +�qu;� �--�---- ----Capacity --- -- --- ---- ❑/' No`. of compartments ---------- -- Size . �' �J 2 Distance from fcunda+ion.___ __..--Distance to nearest hot Length of each line---------� - ..Width of trench._.._-- ----�-- -------- Disposal Field: Distance from nearest well -- Number oz lines-;---- --- Total. -IZ-' or 11 material_ �--•' �RiDepth of filter material----- _ ----- 1 ��-- rw. . , from foundation_______________ __.Distance to nearest lot line Distance to nearest well------ DDepth ie: Diameter ------SSeepa e Pit: Number of pits-------------�-------Lin+"g material ❑ # -`::_.---._---- Distance from,nearest well----------------- tance from foundation- ----- ._Liquid Capacity_.__-------------------•---gals. Cesspool: Depth ❑ � Size: Diameter..------°-------- ----- -- ..� Distance from nearest building------------------------------------------ - ,.a Distance from nearest we --- ----- --------------- ----------- ---------------------------------------------------- Y. ❑ � Distance to nearer} lo} Jine---_--------------------------------- ----------------------•------•-••----------•------- Remodeling and/or repairing (descr+ a):---.----- ---- ----------------- -------•------ --------------------------------•------------------------------ ------- -------------------------------------------•------------------ ---------------------------------y: e I herebycertif that I have prepared this application f the San Joaquin LocalkHelaltheDistrEc{� accordance with San"Joaquin County _ ordinances, State laws, and rules an. regulations Owner and/or Contractor) t f Sined 1__ �..�21( =------------------ ----- ------------ g )------- _ t -. [Title)----� ..��f - C. .e . _ �------- ------- BY Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 p l FOR DEPARTMENT USE ONLY i DATE------ -- - APPLlCAT10N ACCEPTED BY ---------- DATE------- --------1^---•..----•-------------- ------------- ----------------------------- REVIEWED BY---------- -------------- ----------- ---- -- DATE BUILDINGPERMIT ISSUED----------------------------------- ---- - _ .__.------------•------------------------- -;--•--- . Alterations and/or recommendations-------------------------- - ______________ -- ------------- -----------•------------- -- - ---- --- - <� Date FINAL INSPECTION BY--------------- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 014 North "C' Street 300 West oak Street Tracy, California 130 South American Street Lodi, California Mantaca, California Stockton, California rF;-9-2M 145x46 ATWOOD 12-54